A poll by HealthMine found that more than half of Medicare participants didn't know whether their plan would reimburse for telemedicine charges. That could change after a proposed Medicare rule to make it easier for healthcare providers to get paid for providing services via broadband. (HealthLine graphic)

Telehealth Changes Could Help Rural Seniors Age in Place

Telemedicine providers can’t catch senior citizens when they fall. But health services delivered over broadband can make it possible for seniors to live independently for longer periods of time.

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Falling is the number one problem for seniors.

“If a senior falls, many times something will break, which leads to hospital stays, surgeries, and rehabs,” says Anthony Cirillo, president of the Aging Experience. “But really, a person in their 70s or older who has any type of a major medical event often faces a cycle of greater complications later on. It’s the aging process.”

Broadband and telehealth won’t prevent falling, but technology can help keep a person healthy so they minimize the danger of a fall. And it can help seniors recover when they do tumble.

In other words, broadband and telehealth can help seniors (those 65 years or older) remain safely in their homes longer.

There are three categories of telehealth applications that can help seniors to age in place: 1) general medical services, 2) mental health services, and 3) home health care. High-speed broadband makes these telehealth services possible.

Telehealth for seniors got a significant boost last week when Medicare officials stated they are considering reimbursing doctors for telehealth. Current rules tightly control reimbursements for telehealth services, making it less likely that physicians will provide such services to Medicare patients. Nine out of 10 seniors recently surveyed by HealthMine said they either don’t have access to telehealth through their Medicare plan or they don’t know if they have it.

Nevertheless, a sizable number of physicians are increasing their use of telehealth.

In Good Health, for example, is a family practice in Chattanooga. They offer medical home visits for elderly patients who have difficulty getting to the office. The entire practice was part of a pilot test for Docity telehealth products conducted by EPB, the public utility that runs the Chattanooga public broadband network.

Telehealth can reduce significantly the amount of medication that seniors with mental health issues require. Nancy Hamilton, executive director of Hearthstone senior living buildings in Pella, Iowa, says, “In 2015 our anti-psychotropic medications use was at 15.5% and now it’s at 6.8% even though our acuity of patients with behaviors has increased. Encounter Telehealth [their vender] brings constant touch points with psychiatric professionals that we need.”

Katrina Heater, a clinical household coordinator at Heartstone adds, “Encounter’s staff keeps us informed about state and federal policies, new or changed insurance rules, and medications that cause bad interactions with other medications.”

Home Healthcare and Aging in Place

Hospitals can be penalized if a lot of patients get re-admitted within 30 days of their discharge for a problem related to the initial treatment. “This can have a serious financial consequences,” says Cirillo. “Hospitals have a vested interest to remotely monitor you to make sure you comply with follow-up treatments.”

OrthoLive CEO Mike Greiwe says, “We have many patients who are elderly and need remote monitoring, especially right after surgery.” This telemedicine vendor works with home-health monitoring companies and short-tern nursing facilities to enable services that reduce re-admissions. They monitor wound care, surgical incisions, and rehab activities.

Those sensor-enabled products in the “I’ve fallen and I can’t get up” ads years ago have become more sophisticated. Some sensors now can determine whether a patient sat up in bed or actually fell on the floor. “A nurse can determine how long since a person’s been to fridge, a sign an Alzheimer’s patient maybe forgetting to eat or take their medication,” Cirillo says.

But telehealth services can’t help when seniors don’t have adequate and affordable bandwidth.

“Low-income and elderly residents are likely to have a mobile cellular smartphones and not likely to have free wifi at home,” says Angela Siefer, director of the National Digital Inclusion Alliance. “Cellular mobile operators such as Sprint and T-Mobile offer sign-up programs to help these individuals but then put these ridiculous data caps on them. It’s a nonstarter.”

Telehealth venders cannot assume a patient can get to a free, uncapped wifi connection when they need to use a telehealth app. “A patient who just had surgery or has a wound from some accident may need to check-in weekly for the month, but the video consults or sending pictures to a wound specialist may totally blow past the data cap,” Siefer says.

Broadband to Boost Telehealth

For all of the potential that telehealth holds for assisting the aging-in-place process, telehealth’s success rides squarely on the back of quality broadband in the community.

Jennifer Amis, CEO of Encounter Telehealth, is frustrated every time they partner with a skilled facility that can’t meet the vender’s basic bandwidth requirement. “One prospect’s connection was so poor the audio was always out of sync,” she says. “It is a group of 15 facilities and we aren’t able to connect with any of them. I’m sure all of those patients need specialized care they can’t get.”

Municipal fiber networks can drive telehealth and broadband use. Small towns such as Wilson, North Carolina, and Sebewaing, Michigan, with gigabit capacity infrastructure, keep subscribers happy. But even networks with speeds of 50-100 Megabits per second are fast enough for smaller populations.

A fixed wireless network pumping 20-40 megabits of symmetrical (the same upload and download) data speeds can drive telehealth too. Mobile Beacon has a portable wireless solution that serves low-income populations. They sell small portable wifi transmitters with 8-12 Mbps speed and no data caps to libraries. The libraries loan these devices to their patrons for any time between several weeks to six or 12 months. The company is planning a trial program where these devices are part of a telehealth program.

Telehealth vendors and community network builders should consider theirs a symbiotic relationship that benefits communities. There are signs that telehealth is taking hold. Along with last week’s proposed rule from the Centers for Medicare and Medicare Services to reimburse for telehealth came news that the FCC might commit $100 million for telehealth from the Universal Service Fund. With more use of telehealth may come more independence for America’s seniors.